HomeMy WebLinkAboutMortgage_Sisson (3)�� �� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS __
'+• = FOR DEDUCTION FROM ASSESSED VALUATION u' o sh Year
J State Fwm a3709 (R6 / 5461 � ''�
� N� Presmbed by Department of local Gwemment Finance
s.
INSTRUCTIONS: y�
To 6e filed in person or by mail with the CountyAudito� ot the county whe�e lhe property is locafed. .�� ��
Frling Dates: 1J Real Property: Dunng the 12 months betore June 17 of the year the deduction is �q,$g��,o�.1TY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of tKe year the deduction is to be etfective.
See reverse srde for additional instructions and qualifications.
see
Taxing
Assessed value of real property as of
March t, current year
If no, what is his
exact share of interest?
on reverse side)
Rey number / legal description Record numbe� = O�
a�-„- �3 -�-Q, i. ��a -0a age number �� ��
MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitabte
March 1, cur^enl ye`ar owne(? "� Yes ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below:
�e of(1/�o�` rtgagee or contred seller
\ � M li /
Addresa of moRgage or conVaIX seller (number and street, city, state, ZIP
assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP
rV.. V� . V ' ` 7' lP b b
Is the property in questian:
'�eat PropeAy � ❑ Mobile Home (IC G1.1
' .
Dra�ti•cr \'O.. �.7 -..�?.�..% G
Does applicant own property in any other If yes, what county? What l C-1 I"(1 �' �. �
countyin n iana.
.....................
Deduction approved in the amounl of:
20 ��
�
Signature
20
l.
COUNTY AUDITOR
20 20 20
County Auditor
20
Date
20
auested on
� Yes � No
We ceAify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
nature (owners full ame) Person authorized by duly exewted Power of Attomey
��.,,, Cf,� ^ or by IC 6-7.1-12-.07
of authorized person
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